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Avanavancherry Grama Brahmana Samooham Trust

Life Time Membership Registration Form

Personal

Address

Family

Payment

Name

Father's Name

Date of Birth

Age

Star (Nakshatra)

Gothram

Permanent Address

Communication Address

Same as permanent address

Phone

Children Details (No. & Position)

Reference 1 Name

Reference 1 Phone

Reference 2 Name

Reference 2 Phone

Please complete payment to submit application.

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